During the advent of a booming e-commerce over the Internet, many people have become familiar with the flexibility and cost effectiveness of shopping “on line” for various goods via the use of Internet sites that offer public auctioning forums of one sort or another where sellers and buyers may participate in some form of interactive bidding process. However, while on-line auctioning has been employed somewhat successfully in the context of bartering for various products, problems arise when trying to accommodate the need for assessing professional service provider qualifications, scheduling, location and quality. One of the problems confronting a consumer willing to bid on-line for professional services is that there is not any convenient means for verifying the qualifications or for assessing the quality of services likely to be rendered by a prospective unknown service provider who puts up his/her services for auction. Moreover, it would be highly desirable for someone in need of medical services to be able to have access on-line to a convenient “one stop” full service market place that can provide access to health care payment plans, various financing options and even related insurance products. For example, most medical care consumers would find it very helpful to have access to an Internet web-site or service that offers an on-line medical services information repository or provides a convenient and comprehensive way for researching the reputation and quality of various healthcare service providers. It also would be very convenient and useful for on-line consumers to have the ability to access a single main Internet web-site or home page that provides Internet links and/or on-line tools that automatically perform or at least assist in arranging financing and making payment arrangements for procured medical/healthcare services. Furthermore, it would be very convenient and useful for an on-line consumer to have the ability to search and access related services such as medical insurance coverage for procured services through the same main Internet web-site.
On-line auction systems are known to have been attempted only for a few types of professional services. For example, U.S. Pat. No. 6,006,191 to DiRienzo (1999) discloses a system wherein certain limited medical services of remote physicians' are auctioned, to wit, DiRienzo is specifically directed toward the reading of radiological and other medical images (i.e., image-reading diagnostic services). In this context, DiRienzo generally teaches:                “ . . . The essence of the invention is the use of a decentralized, i.e., self-organizing, distribution system combined with bid queues to establish a market place which allows for continuously negotiated prices with control (over who reads the images, when they are read and what the fee will be for such a reading) being totally in the hands of the patient/gate keeper and the diagnostic physician.” [column 8, lines 31-37].        
Additional prior art patents of possible interest include:                U.S. Pat. No. 5,918,208—Javitt (1999)        U.S. Pat. No. 5,964,700—Tallman et al (1999)        U.S. Pat. No. 5,995,939—Berman et al (1999)        U.S. Pat. No. 6,014,629—DeBruin-Ashton (2000)        U.S. Pat. No. 6,035,288—Solomon (2000)        U.S. Pat. No. 6,289,319—Lockwood (2001)        
Javitt is directed to a system that allows a doctor to forecast utilization of services. Tallman et al discloses an on-line system that allows an insurance company member to select the most appropriate doctor. Berman et al teaches an e-mail system between doctors and others involved in a specific patient's health care. DeBruin-Ashton teaches a method of compiling a customized directory of medical service providers for a particular patient. Solomon is generally directed to on-line bidding for a service (i.e., any service, medical or otherwise) in which the price can be negotiated. Lockwood discloses an automated business and financial transaction system terminal for filing and processing loan applications and the like with a financial or banking institutions to make their services available at all hours from one or more remote locations.
More recently, a company called HealthMarkets, Inc. is purportedly providing an on-line resource for locating and comparing prices of proffered health care services/physicians for the purpose of selling insured Consumer Driven Health Plans. (This company currently maintains an Internet web-site having a uniform resource locator (URL) address of “HealthMarkets.com”). However, the company does not contract directly with health service providers nor does its web-site allow on-line customers to do so. Moreover, its web-site does not provide or support on-line auctioning of professional healthcare/veterinary services or act as a one-stop marketplace for the on-line shopping of professional healthcare/veterinary services and providers.
There are also at least several well known on-line auction and reverse bidding systems such as eBay (eBay.com) and Priceline (priceline.com), but likewise, these services do not provide on-line auctioning of professional personal and/or veterinary services or serve as a on-line marketplace for conveniently researching, procuring and financing such services.
In this regard, there exists a need to provide on-line consumers with a single convenient Internet web-site source for conducting healthcare service research, participating in healthcare service auctions and fee negotiation, making healthcare payments and related financial arrangements and/or obtaining related services such as medical procedure insurance coverage.
The illustrative exemplary non-limiting implementation described herein provides a comprehensive on-line healthcare marketplace (healthcare market exchange) and web-site for obtaining healthcare services and products that is accessible via the Internet using a conventional PC with a browser and which enables an on-line visitor/user to the web-site to participate in on-line auctions and price negotiations for proffered professional services, conduct on-line research to find an appropriate healthcare service provider, arrange financing and manage payments for purchased healthcare services/products and, inter alia, review medical insurance products and procure insurance coverage for rendered healthcare services.
In addition, the exemplary non-limiting illustrative embodiment disclosed herein is contemplated to provide an online bidding site for a wide variety of healthcare providers including all physicians, Cosmetic Surgery, Dentists, Vision Specialists, Chiropractors, MediSpas, Allied Health, elective procedures and professional veterinary services, and animal healthcare and grooming services. The exemplary non-limiting illustrative embodiment disclosed herein also enables a consumer to search for and select healthcare providers via a dynamic online, competitive bidding process, where doctors offer discounted prices and actually compete for business. The exemplary non-limiting illustrative embodiment disclosed herein provides consumers with comparative pricing information for various medical, dental, vision, chiropractic, cosmetic, medispa, allied health, elective procedures, professional veterinary services, and animal healthcare and grooming services. On-line users are also able to review details about service providers' professional practice as well as their credentials. In addition to human healthcare service providers, the exemplary non-limiting illustrative embodiment disclosed herein also acts as an online marketplace for connecting consumers looking for veterinary services, animal healthcare or animal grooming services with qualified professional service providers. In addition, the exemplary non-limiting illustrative embodiment disclosed herein helps consumers to compare and negotiate pricing on professional services and procedures in a given location in the U.S. while the providers receive the benefit of generating patients/consumers who are willing to pay directly, out of pocket to the provider for their services. Some exemplary services and procedures contemplated include dental (teeth cleaning, crowns, fillings, braces, whitening, etc.), common and preventative medical procedures (physicals, mammograms, vaccines, x-rays, etc.), vision (glasses, contacts, LASIK and PRK surgery, eye exams, etc.), cosmetic (liposuction, breast enhancement, Botox, face lift, etc.), weight loss (dieticians, nutritionists, etc.), chiropractic (back and neck pain, arthritis, soreness, sports injuries, etc.), general well-being (acupuncture, hearing aids, physical therapy, massages, etc.), as well as professional veterinary services, and animal healthcare and grooming services.
Traditional transactional costs associated with providing professional services are reduced by enabling prospective clients/patients and professional service providers to competitively negotiate fees for proffered services through an interactive professional services auction transaction system implemented on-line over a publicly accessible communications network such as the Internet. A separate on-line auction transaction system, which shares database resources with the professional services auction transaction system, is also provided for implementing an arrangement for auctioning options to purchase services (i.e., a service option) at a discount (e.g., discount coupons or analogous vehicles that are applicable toward fees charged for proffered professional services). A person-to-person network marketing arrangement and method for rewarding existing member professional service providers for recruiting prospective new service provider members and training them in the use of the on-line auction transaction systems is also fostered and supported via the on-line professional services auction transaction system. Using the same arrangement, prospective users of the on-line auctions may be rewarded for usage training and recruitment of new users.
In at least one aspect, the illustrative exemplary non-limiting implementation of an on-line healthcare market exchange disclosed herein provides a professional services auction transaction system using a digital communications network server that interfaces and communicates via the Internet with client computer systems belonging to various prospective bidders and professional service providers (e.g., personal medical, financial or legal service providers) using, for example, an exchange of HTML documents and/or JAVA script applets. A transaction system server handles on-line communications and procedures for conducting public on-line auctions for the performance of proffered professional services and maintains one or more databases of information concerning registered service providers and bidders. An authentication/qualifier engine within the system automatically researches and verifies the credentials of prospective member service providers, as well as maintains background information on all registered service providers.
Databases containing a professional service provider's credentials and other information relating to their qualifications for providing a particular medical/veterinary service, as well as one or more search engines for researching and/or verifying archived qualifications/credentials of a particular service provider are made available on-line to a member/bidder via the on-line healthcare marketplace's web-page menu driven interface. An on-line user service feedback web-page and database are provided for acquiring and maintaining comments and feedback from both service providers and their patients/clients regarding the complexity and quality of services received or provided. The transaction system may also include remote client-server hardware/software facilities for providing customized database and computational services to auction bidders and professional service providers for communicating and participating in on-line bidding activities. An integrated life and health insurance product is also provided that permits trading equity in health insurance policy death benefits when bidding for health care or medical services used for the purpose of life prolongation. The illustrative exemplary non-limiting implementation of an on-line healthcare market exchange disclosed herein is described primarily in the context of providing an on-line auctioning process for the purpose of negotiating the price for the performance of a particular personal medical service by a professional medical physician on an individual patient—this is in contrast to the obtaining of an ‘impersonal’ professional service or opinion that is rendered remotely such as, for example, the reading of an X-ray or an MRI image. The non-limiting example illustrative on-line healthcare market exchange implementation disclosed herein, may also be used to provide the flexibility of an on-line auctioning process for soliciting discount coupons/certificates or developing a user marketing/training network and/or for marketing other professional services such as, for example, legal or financial services.
In the context of providing an on-line auction forum for professional services, it is desirable to prospective bidders to have a convenient mechanism to verify that a selected service provider is properly qualified to perform an offered service and for informing the bidder as to the likely quality of the service to be provided at a particular time, location and price. Another problem that arises within this context is that a medical service provider has no convenient way to assess the history or physical condition of a prospective patient/pet. Since the extent and cost of treating a particular patient/pet may depend upon the patient's/pet's medical history, it may be difficult for a provider to affix a specific offering price on a particular medical service or procedure. Consequently, one beneficial feature of the exemplary on-line healthcare market exchange disclosed herein is the implementation of an on-line provision for allowing prospective medical service providers to assess the physical condition and medical history of a prospective patient. In addition, the exemplary on-line healthcare market exchange implementation disclosed herein provides a fair and symmetric mechanism for accommodating errors made in the appropriateness of rendering a particular medical service or procedure without having full knowledge of a patient's pre-existing medical condition.
In the context of obtaining personal medical services on-line, people who are uninsured or only partially covered by an insurance policy are provided a more convenient mechanism for identifying and contacting a high quality, qualified medical service provider that will provide a desired medical service at the desired quality, time, location and price. Medical service providers who own or operate medical facilities for performing such services are often willing to reduce fees if it would enable them to keep the staff and resources of their facility from being underutilized. For example, during slow or inactive periods, the under utilization of facility and staff reduces profitability and thereby drives up costs for conventionally scheduled patients.
At least one aspect of the exemplary on-line healthcare market exchange system and method enables an on-line feature/tool whereby a patient, or an agent acting on a patient's behalf, or an insurance company to perform research to identify an under-utilized medical facility. This tool/feature provided by the healthcare market exchange web-site can reduce the cost of a medical service or procedure by enabling, for example, an insurance company to negotiate a lower price for the policyholder who elects to receive treatment at that underutilized facility. For example, an uninsured patient may also use the on-line healthcare market exchange to secure medical services at a favorable price by agreeing to have the desired service performed during a period of what is otherwise expected to be facility underutilization. Such underutilized medical facilities and medical service providers also may agree to lower pricing if they receive payment at time of bid closure instead of, for example, after a customary 8-12 week post-service insurance reimbursement delay.
Subject to certain restrictions, such as the availability of an otherwise under-utilized medical facility in reasonable geographic proximity to the patient, a novel type of medical insurance policy may be offered wherein the policyholder agrees to have a desired medical procedure or service performed at an otherwise underutilized facility at “market value.” The cost for such a “market value” policy can be reduced because the insurer may be able to negotiate a lower price for securing a needed service on a case-by-case basis (e.g., by contracting to have a service performed at a particular time, or within a specified range of times, in an otherwise underutilized facility). Alternatively, a novel lower-cost lifetime (or shorter period) maximum benefit insurance package could be offered in such a market. For example, the premium rate for such an insurance policy could be set proportional or inversely proportional to the residual benefit in either a linear or a non-linear fashion.
Yet another alternative is that a novel insurance package be provided in which health and death benefits are combined together. In accordance with one such contemplated example insurance package arrangement, the accrued death benefit of the policy (e.g., using the standard life insurance policy model) can be used to bid for health benefit services to preserve life. The expense (e.g., finalized bid price) of the rendered medical services is taken from the policy residual death benefit and the policy holder's death benefit then becomes the remaining balance. This creates a situation of finite resources that will impose market forces on health providers where each consumer strives to get the best quality for the best price and preserve the remaining benefit for themselves and their families. The individual again is empowered to make those critical heath care decisions and impose market forces on existing providers by means of this device and method.
Another aspect of the exemplary on-line healthcare market exchange system and business method implementation described herein is to provide members and participants with links to insurance providers, as well as to provide new types of medical/health related insurance products such as medical mal-occurrence coverage and medical warranty coverage (explained below), and also to provide on-line interactive tools to simplify the process of selecting and purchasing such. It is also anticipated that such insurance products and medical services obtained through the healthcare market exchange web-site may be purchased using funds from a personal healthcare savings account or other personal finance and that the transactions be automatically performed by the on-line healthcare market exchange system.
As mentioned above, an aspect of the exemplary on-line healthcare market exchange (HME) system and business method implementation described herein is that it offers on-line, or makes available through on-line transaction, a form of “no fault” medical mal-occurrence (i.e., mishap) insurance coverage that may be purchased on-line per transaction/medical event by a healthcare/medical service provider when providing a particular healthcare/medical service to a patient. The cost of this medical mal-occurrence insurance coverage is determined by factors such as historical provider outcomes, hospital outcomes, procedure complexity, patient complexity and other factors are made readily available on-line to an qualified insurance underwriter via the in the HME system databases. Different insurance underwriters may be asked to make online competitive offers to predetermined coverage parameters provided by the HME system so as to not confuse the consumer with small print coverage variations.
As also mentioned above, an another aspect of the exemplary on-line healthcare market exchange (HME) system and business method implementation described herein is that it provides or makes available through on-line transaction a medical warranty coverage insurance product that is tailored to cover such additional medical care expenses that result from unanticipated medical expenses encountered during performance of the specific purchased service (i.e., a single medical event/service). This medical warranty insurance coverage can either be purchased by the consumer or be built into the price of the purchased medical service. The price for warranty coverage for a specific single medical event may be determined by similar event-related statistics data available on-line to the underwriter from an HME system database. Multiple underwriters may be allowed to compete with each other online. Thus, the price for such health event warranty coverage might vary but the coverage criteria will remain invariable so that the consumer is not unduly confused by coverage variations among different underwriters.
Another aspect of the exemplary on-line healthcare market exchange (HME) system and business method implementation described herein is that it provides or makes available on-line a medical/health event-specific insurance product (i.e., insurance coverage for a specific health service) whose pricing is determined by statistical data or information contained and maintained in one or more of the HME system databases. Such data is made available to insurance product underwriters and may include, inter alia, accumulated procedural “outcomes” data for a particular healthcare service provider, a particular medical/health event, a particular hospital or specific service, pertinent medical complexity, provider and patient feedback data, location of service, etc. In this manner, a healthcare service insurance coverage for a mal-occurrence and/or warranty is provided that has a previously unprecedented accuracy for actuarial pricing as well as the option for allowing competing insurance product underwriters to offer their products (coverage) by means of their own proprietary pricing algorithms.
Typically, facilities providing medical services, particularly elective procedures, spend a significant portion of their operating budget on advertising and promotion. An important purpose of the advertising is to assure that the facility is fully utilized. The illustrative exemplary non-limiting implementation of an on-line healthcare market exchange disclosed herein provides an altogether different means for assuring efficient utilization of a medical facility. With the disclosed healthcare market exchange implementation, even if medical services were to be provided at a reduced price, the savings realized by reduced advertising and promotion can be shared with the patient, thereby reducing overall medical costs for the consumer and increasing profitability for the medical service provider. More particularly, the illustrative exemplary non-limiting implementation of an on-line healthcare market exchange disclosed herein provides a method and system that will enable prospective patients to easily identify and access an otherwise underutilized medical facility to negotiate a favorable fee for services subject to scheduling restrictions and other “specifications” set by the medical service provider. Likewise, underutilized medical facilities may now offer services at a negotiable fee in order to more fully utilize the resources of the facility.
Conventionally, most medical services are sold under a fixed-price protocol whereby the medical service provider sets a price for the service and a patient either accepts or rejects the price. The time, and sometimes the place, that the services are rendered in accordance with this protocol may be regarded as “flexible” in the sense that a medical service provider will typically establish a time and place (i.e., specifications) for rendering the service that is mutually acceptable to the parties. However, alternative protocols for perfecting buy-sell transactions between patients and medical service providers that are responsive to market forces, such as, for example, an auction or an exchange for buying or selling medical services similar to a stock exchange, have not been traditionally available.
Market research has indicated that people, lacking insurance for reimbursement of drug costs, typically pay as much as 15% more for a prescription medicine than people having such insurance for the same medicine. For example, seniors without drug coverage may not only lack insurance to protect against high costs, but may not have access to discounts and rebates that insured people receive. Uninsured persons may not purchase a needed prescription medicine simply because they cannot afford it. Moreover, market research indicates that spending for prescription drugs is currently growing at a rate that is twice that of other types of healthcare expenditures. This perceived inequity in pricing between insured and uninsured prescription medicine buyers now may be diminished by the on-line healthcare market exchange disclosed herein which seeks to provide a marketing system and method that enables the uninsured to buy prescription medicines at a “fair market price” that is both dynamic and determined as a result of competitive market forces. For example, overstocked medications that are to expire in six months may be sold at half price to those patients that can use them immediately.
The exemplary on-line healthcare market exchange disclosed herein more efficiently schedules personal physician procedures during known predictable slow times (for instance during the night) so as to better match medical resources with medical needs across geographic/time domains. For example, the exemplary on-line healthcare market exchange system also provides an automated arrangement whereby a doctor is enabled to first accept certain bid/cost proposals for his/her services and then decide whether to accept or decline the bid price (thus more efficiently and economically distributing medical services to desiring patients that might pay a lower cost because the procedure would be done during “off” hours or the like).
The illustrative exemplary on-line healthcare market exchange (HME) described herein may be implemented using a client computer system or suitable handheld wireless device comprising a telecommunications link to a remote medical transaction server via a digital communications network, such as the Internet, for enabling prospective buyers of medical services to negotiate with providers of medical services to identify and secure a reduced market-driven price for desired medical services. If desired, a condition may be imposed so that that the services will be rendered by the facility during a period of what would otherwise be facility underutilization. The illustrative exemplary on-line healthcare market exchange described herein may also be implemented using a programmed computer transaction system connected via telecommunication links to a digital communications network, such as the Internet, that enables a plurality of prospective sellers of medical services to offer medical services to patients, insurers and other third parties using an auction format. A minimum reserve price may be established for bids received using an auction format.
A buyer and seller of medical services can also communicate with each other to establish a mutually acceptable fee for services, the mutually acceptable fee being subject to a medical evaluation and restriction regarding the time and place where the medical services will be provided. Options may be provided in choosing a less convenient time and place for receiving medical services in exchange for a better price for his/her needed medical services. The qualifications of a medical service provider for the provision of an offered medical service may be authenticated. In fact a buyer and seller of medical services may have access to each other's respective transaction history and feedback history.
Another aspect of the illustrative exemplary on-line healthcare marketplace or market exchange (HME) implementation described herein disclosed herein provides a business method and system for providing an on-line auction of an option to purchase services (i.e., a service option). As an example embodiment, medical services and/or medical supplies (e.g., prescription medicines) may be offered for sale in an on-line auction forum subject to selected conditions that can be specified by a medical service provider such as, for example, the time and/or place where the personal medical service is to be rendered. In addition, the illustrative exemplary implementation of the on-line auction and health market exchange (HME) transaction system disclosed herein further provides a business method and system for providing an on-line auction of options to purchase services at a discount and/or analogous options. As an example embodiment, discount coupons to purchase proffered medical services at a discount may be placed up for auction on line by a medical service provider.
In addition, another aspect of the exemplary on-line healthcare market exchange transaction (HME) system implementation disclosed herein is that it will enable patients, whether insured or uninsured, to acquire elective surgical services, chronic rehabilitation services, medical equipment support, and other non-emergency medical and dental services through an auction format bidding process. Various covered and non-covered services such as podiatry, chiropractic, acupuncture, homeopathic, behavioral modification treatment and therapy, weight loss, hypnotherapy and other health related services may also be included for on-line listing and bidding in an auction format using the exemplary HME system implementation. Although many medically-related health services and products are subject to regulation to assure quality, the establishment of specific qualifying conditions and quality control measures are easily implemented by the HME system described herein.
An efficient arrangement is also provided for on-line solicitation of consumer feedback information from patients which, after being acquired, is maintained in a transaction database and made accessible to other prospective patients. The convenience of on-line availability of a consumer feedback database to prospective patients and other buyers of medical services should ultimately serve to improve the quality of medical services provided to patients.
Another aspect of the exemplary on-line healthcare marketplace or HME implementation disclosed herein is that a person desiring a specific medical service is provided with a means to identify a medical facility offering such services and can negotiate obtaining the services at a “preferred” price in return for agreeing to receive the services during a period of otherwise expected facility underutilization.
A yet further feature of the exemplary healthcare market exchange transaction (HME) system described herein is that it allows a “standby” option to be implemented wherein the performance of services are provided at a reduced rate to a buyer willing to accept treatment on a “standby” or delayed basis. This is particularly beneficial in that it provides a further component of cost reduction to the patient and/or his/her insurer and could provide the medical provider with greater assurance that revenue is not lost. Using the bidding/auction-type format, payment (either partial or full) may be made or secured electronically at the time a bid is accepted (rather than the customary 8-12 weeks after provision of a service, a basketful of paperwork and a plurality of phone calls).
A practical market-driven system that permits efficient buying and selling of medical services should also be subject to both strict quality control and acceptable practices by the medical community. Consequently, another aspect of the exemplary healthcare marketplace or HME implementation disclosed herein is that a medical service provider's qualifications are preferably authenticated/verified using an authentication engine prior to posting either a global or local offer to sell a service. In addition, an offer-acceptance agreement between a medical service provider and a patient may also be optionally qualified by a restriction that a patient submit to a medical evaluation to establish the appropriateness of the medical service for the particular patient.
Another feature of the exemplary healthcare market exchange transaction (HME) system described herein is that a qualified buyer of prescription and/or of the exemplary healthcare market exchange transaction (HME) system described herein is non-prescription medicines is permitted to post a proposal to buy medicine at a particular price, for example, via a database accessible to qualified vendors, and may also receive offers for sale of the same medicine from one or more qualified venders at a proposed purchase price.
Direct links to one or more transaction feedback databases are also provided to allow consumers of medical services to verify and evaluate a particular provider's product or service. The exemplary healthcare market exchange (HME) transaction system disclosed herein also allows for an agreement between a patient and a medical service provider to be conditioned on the establishment of medical fitness conditions of the prospective patient for receiving a particular medical service.
The illustrative non-limiting exemplary on-line healthcare marketplace or market exchange (HME) implementation disclosed herein further includes distinct auction transaction engine components for the purpose of supporting a separate on-line auction (i.e., separate from the professional medical services auction) for the auctioning of options to purchase proffered services at a discount (i.e., discount coupons) or analogous options for obtaining discounts that are redeemable against winning bid fees charged by a service provider for the proffered services. Using this aspect of the on-line HME system, a service provider has a choice of either providing a pricing profile listing proffered services with specific associated minimum bid prices on the services auction web-site or, if not willing to disclose a pricing profile or specific prices for proffered services, the provider may alternatively (or additionally) offer a discount coupon for specific proffered services on the associated discount coupon auction web-site. The exemplary on-line HME transaction also combines the use of distinct auction transaction engine components with the sharing of common database elements for further facilitating the on line auctioning of such discount coupons (and/or analogous options to purchase services at a discount) in cooperation with a separate on line auctioning system for products/services.
As still a further feature of the exemplary on-line healthcare marketplace or market exchange (HME) implementation disclosed herein is that it also provides a method and arrangement for implementing on line a person-to-person network marketing business model for rewarding existing member professional service providers for the recruiting of prospective new service provider members and for training them in the use of the on-line auction transaction systems described herein. A user network of training and rewards can similarly be implemented. This aspect of the HME system promotes the creation and development of a network of service provider members (and to a lesser degree purchases of health services) for the recruitment and training of additional service providers.
To provide an improved and enhanced overall on-line bidding experience to the consumer of a professional's services and to more effectively influence on-line offers made by professional service providers, the inventors realized that the on-line market exchange should also provide the on-line bidding consumer with an easy and convenient mechanism for arranging financing and paying for on-line bids. Accordingly, a financing and payment mechanism is provided in the form of a “health card” which, for example, may have the physical appearance of a conventional credit/debit card and may easily be implemented using a similar underlying infrastructure and technology. As an illustrative example, a health card may be integrated with the on-line medical services auction system and may also be customized with specific properties and limitations to make its use safe, secure, practical and feasible. For example, financing/payment of on-line bids may be accomplished through the use of the health card. Of course, any “health card” implementation as disclosed herein is intended to also incorporate any necessary security related and legal restrictions on its use such as, for example, restriction of its use to only health/medical related services and products.
The exemplary health card is preferably implemented in a manner that makes a variety of different financing options available to the member/user. Moreover, various custom financing arrangements may also be added as enhancements to the health card basic features. An integration of the disclosed example health card financing method and arrangement into the competitive pricing arbitration and on-line bidding system described in parent patent application Ser. No. 09/725,142, now U.S. Pat. No. 7,657,479, which is incorporated herein by reference, should act as a significant enhancement to the performance and market implementation of the overall system as described. The incentive is placed on an individual desiring to obtain non-emergency health services to at least make a few attempts to find determine the best price for an office visit or a consultation which he/she may require. The illustrative example health card mechanism and financing arrangements disclosed herein is intended to be used in conjunction with the disclosed networked on-line bidding system so as to aid a member/user in negotiating a best possible price for health services in a manner that makes the quality of the health/medical service provider fully transparent to the bidding consumer.
It is also intended that a robust variety of financing options are made available to a user of the health card. In the non-limiting implementation disclosed herein, some example financing options/arrangements made available to a user of the health card include: 1) use of the card to automatically draw against a user's HELOC (Home Equity Line Of Credit); 2) the card may used to draw against a user's life insurance cash value; 3) the card may be set up to automatically draw against death benefits of a life insurance polity; and/or 4) the card may be used to automatically access a user's Health Spending Account (HSA) or Medical Savings Account (MSA) maintained by an employer to finance qualifying health expenditures using pre-tax income dollars. Moreover, with this last example, the ability of a user/bidder to automatically access their HSA and/or MSA account to finance bidding and payment for rendered services further enhances the value of having an HSA and MSA. A still further aspect of the health card financing mechanism disclosed herein is that specific financing options and/or a particular pre-determined sequence for debiting payments from different accounts may be selected and/or programmed by the user/member on-line, for example, via a secure data link. When confronted with an unexpected and uncovered health event, an individual will have the option to raise money from variety of sources and literally shop for the cheapest available financing dollars.
Federal and state legislation now permits businesses and individuals to setup a health plan savings/flexible spending account. Such accounts are typically restricted in use to saving funds for medical expenses and health related services. One type of such flexible spending medical account attaches to the individual and follows the individual through different employers. Unused funds may accumulate and may be used in subsequent years. Funding for such accounts may come from pre-tax dollars contributed by the employer and/or the employee. For example, a portion of an individual's health savings/spending account may be funded by the employer and a portion by the individual account owner. Such accounts may generate interest income and growth but are restricted in use in that withdrawals from such accounts may only be used for paying health/medical related expenses necessary for maintaining the well being of the account holder.
Moreover, it is recognized that there is presently a growing trend of corporations offering high deductible insurance coverage to their employees due to the lower monthly premiums associated with this type of medical coverage. High deductible insurance provides full coverage to an employee and their family after a deductible ranging from $2,000-$5,000 (or greater if selected) is satisfied. Today approximately, 5% of corporations offer their employees high deductible health insurance. According to the Robert Woods Johnson Foundation, the number of corporations offering high deductible health insurance is projected to experience a 1400% increase over the next two years. Inherent to the increased offering of high deductible medical coverage is an increase of individuals required by their employer to self-finance a portion of their healthcare services. The federal government recognized this growing shift toward self-financing healthcare and, in response, passed legislation in January of 2004 creating a Healthcare Savings Account (“HSA”) program for individuals carrying high deductible healthcare coverage. These individuals can open an HSA with a qualified financial institution and deposit pre-tax dollars in this investment account that remains with them year after year. They can also withdraw funds from this type of account without having to pay taxes when they use these funds for health related expenses.
The exemplary on-line healthcare market exchange (HME) implementation disclosed herein further provides a website where employees can negotiate preferred pricing with healthcare service providers (e.g., doctors, nurses, HMOs) for health services for which they are paying out of pocket. This negotiation opportunity reduces the amount of funds an employee needs to withdraw from his/her HSA thereby maximizing the value of these pre-tax dollars. Moreover, the exemplary on-line healthcare market exchange implementation disclosed herein achieves significant cost savings by continued use of on-line pricing arbitration between patients and health providers. Once the patient has reached their deductible for that year the HME insurance will reimburse or cover the patient for 50-85% of their negotiated health spending, depending on the coverage chosen. The patient remains in the driver seat of choosing their physician, and the proportional co pay provides motivation to negotiate with the health provider for best quality at best price. The health provider is competing against other providers on price and quality to capture the patient with a specific health problem. HME saves money by not having to have many negotiated contracts with multiple providers in multiple communities (a costly paperwork affair).
The patient negotiates best price from their chosen physician and the HME coverage plan spending is protected in part by the co-pay and in greater part by on-line market pricing of services free of processing costs. In this regard, the inventors believe that if doctors are allowed to treat patients and receive immediate payment or prepayment, are spared from labyrinthine processing and billing delays, they will offer significant cost savings to patients and subsequently to HME as the insurance underwriter for spending beyond the deductible fence. The patient benefits from choices, the provider negotiates with the patient, and health spending is controlled by the patient and not by a third party interested in profits, increased premiums and denial of care. Consequently, the exemplary HME implementation disclosed herein is arranged to make healthcare services easily accessible to all including the uninsured, the “deductible” market and those having an HSA program.
The exemplary on-line healthcare marketplace or market exchange (HME) implementation disclosed herein enables individual on-line users, employers, finance brokers and insurers to find, evaluate, compare, negotiate and bid on the purchase of health care services and products. The exemplary HME also provides on-line users with access to comprehensive information on treatments and detailed profiles on medical service providers, including clinical abilities and the minimum bidding prices for the different types of professional services/procedures offered.
In a more general economic context, the disclosed exemplary implementation of an on-line healthcare marketplace/market exchange (HME) provides an efficient apparatus and method for exerting market forces on the costs of delivering professional services and for streamlining potentially costly administrative procedures associated with providing such services. The on-line HME business method and system disclosed herein enables free market forces to play a part in the negotiation, optimization and determination of medical service value while facilitating the connection between physicians and cash paying patients. The on-line HME is a market-driven, price and quality automated arbitration system and method that interfaces well with the uninsured, the underinsured, and the self-insured patient populations so that these individuals can benefit from competitive healthcare pricing.